Metastasis-induced acute pancreatitis (MIAP) is a same rare initial manifestation of lung cancer.

Metastasis-induced acute pancreatitis (MIAP) is a same rare initial manifestation of lung cancer. A review of individual institution's experience and the English language medical literature was waysed to define the incidence, natural history, and optimal treatment of this unusual clinical question One of 802 (0.12 percent) lung cancer patients existinged with MIAP. Seven additional cases were place in the literature. Small-cell carcinoma was not away in six of eight patients. Prognosis is poor. Four patients died within sum of two units weeks of hospital admission. In patients with small-cell carcinoma and mild pancreatitis, chemotherapy may favorably influence redemption from pancreatitis. Those with plain pancreatitis tolerate chemotherapy poorly and initial supportive management is advisable. Patients with small-cell histologic features who repair from pancreatitis should receive chemotherapy. Survival beyond six month is possible. (Chest 1993; 104:98-100)

Pancreatitis metastases are relatively general in advanced bronchogenic carcinoma, however metastasis-induced acute pancreatitis (MIAP) is unusual.[1,2] Acute pancreatitis is rarely the initial manifestation of lung cancer. Because this clinical scenario is sufficiently different from MIAP developing after diagnosis and treatment of lung cancer, separate consideration and analysis are warranted. hardly any data are available concerning incidence, prognosis, and treatment. To gain a better understanding of this rare clinical question we undertook a review of our institution's experience and a collective review of cases reported in the medical literature.

systems AND MATERIALS

Records of patients with a diagnosis of acute pancreatitis or bronchogenic carcinoma at the Misericordia Hospital from one side of to the other a ten-year period were retrospectively reviewed. Patients diagnosed as having one as well as the other conditions, either synchronously or with pancreatitis preceding lung cancer, were identified. Patients were exclud if pancreatitis expanded after a diagnosis of bronchogenic carcinoma had been established.

The English language medical literature was searched at Medline and by manual manners to identify reports of bronchogenic carcinoma with acute pancreatitis as the initial manifestation. The denominations pancreatitis and lung neoplasms were used. mostly retrieved reports were excluded because pancreatitis was seldom the initial manifestation of lung cancer.

RESULTS

across a ten-year period, 802 patients with bronchogenic carcinoma and 614 patients with acute pancreatitis were treated at the Misericordia Hospital in Edmonton, Canada. Four patients initially diagnosed as having acute pancreatitis were subsequently build to have a bronchogenic carcinoma (05 percent of lung cancer patients). Three of these patients were exclud from consideration. undivided patient, with a long history of alcohol abuse, tolerateed from acute pancreatitis ten month prior to the diagnosis of small-cell lung cancer. The couple conditions were undoubtedly unrelated. The secondary patient died of small-cell carcinoma of the lung undivided month after being hospitalized with acute pancreatitis. Although pancreatitis may have been secondary to pancreatitis metastases, gallstones were ready and alcohol abuse was suspected. Comput tomography may have clarified the etiology, unless it was not required for patient treatment and was not obtained. The third exclud patient was admitted to the hospital with abdominal pain and a serum amylase horizontal over 1,000 U/L. Chest radiography showed a right lower lobe mass and bronchoscopy was positive for small-cell carcinoma. Multiple visceral metastases, including pancreatic metastases, were suspected. The patient decided against extensive investigations, as it was as abdominal computed tomography, and declined chemotherapy treatment. He died at family 11 days after hospital admission. Amylase isoenzyme assay was positive for salivary amylase, a finding indicative of ectopic amylase secretion. The clinical diagnosis of pancreatitis was probably erroneous and this patient was exclud The single in kind patient with strong evidence of MIAP as the initial manifestation of bronchogenic carcinoma exhibits 0.12 percent of lung cancer patients and 016 percent of patients with acute pancreatitis in this series.

Collective Review

Seven reports of acute pancreatitis as the initial manifestation of bronchogenic carcinoma were base in the English language medical literature (Table 1)[3-9] Five of seven tumors were small-cell carcinomas. Mean age was 57 years. Survival ranged from 8 days to 8 weeks with a mean survival of approximately four weeks from first brunt of pancreatitis. Four patients died within 2 weeks of hospital admission. couple patients who received chemotherapy died within 6 weeks. [TABULAR DATA OMITTED]

CASE REPORT

A 44-year-old woman was admitted to the hospital with acute abdominal pain and a serum amylase of the same height over 1,000 U/L. Abdominal comput tomography demonstrated a pancreatic mass (Fig 1) Carcinoma of the pancreas was suspected. Endoscopic retrograde pancreaticocholangiography showed obstruction of the pancreatic channel Bone metastases were quick in emergencies on radioisotope bone scanning. Acute pancreatitis resolv with supportive treatment. Chest radiography showed opacification of the left lower lobe (Fig 2) Because the radiographic appearance did not improve with antibiotic treatment, bronchoscopy was indicated. Bronchoscopy was positive for an obstructing small-cell carcinoma of the left lower lobe. Endoscopic findings were typical of bronchogenic carcinoma as oppos to pulmonary metastases. She rejoined partially to three courses of cisplatin and etoposide. Malignant bile pipe obstruction required palliative percutaneous transhepatic biliary drainage. She remains alive, unless with advanced disease, 6 month after her initial presentation with pancreatitis.

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